Augusto Lauro, Chiara Zanfi, Sara Pellegrini, Alessandro Dazzi, Matteo Cescon, Giorgio Ercolani, Luca Ansaloni, Giovanni Ramacciato, Fausto Catena, Loris Pironi, Antonio Daniele Pinna

Liver and Multiorgan Transplant Center, S. Orsola Hospital, Bologna, Italy

Aim: We report our experience about surgical and transplant intestinal approach on adults with complicated intestinal failure.

Methods: Between 2000-2011, 93patients were evaluated for surgical bowel rehabilitation.

Forty-five (48,3%)underwent 46 transplantations (34 isolated, 12 multivisceral), due to SBS,Gardner's ,CIPO.

Forty-eight (51,7 %)underwent surgical rescue (due to fistulas, stenosis, SBS, complete portal thrombosis) with resection, adhesiolysis, stricturoplasty, OLTx with porto-caval hemitrasposition (5 patients-rescuing own bowel).

Results: Among transplant population (mean followup 1561 ± 1294 days) 22 (47.8%) are alive with 1-3-5-10 years patient survival of 77%, 58% , 53% ,37%; 1-3-5-10 years graft survival is 68%, 56 % , 51% ,35%.

Thirthy-two underwent Alemtuzumab induction(plus FK), 12 Daclizumab(plus FK-steroids) ,2 Thymoglobulin (plus FK): on 11 we applied new Alemtuzumab protocol, administering 15 mg each patient at day 0 and 7 , instead 4 doses -eight patients are alive.

Currently, 56% intestinal recipients and 25% multivisceral ones are alive: survival in alemtuzumab group after 3,5 ,7 years was 49%, 45% , 45% while in daclizumab one was 75% , 66% , 50% (P=0,56). Younger recipients (< 40 years at transplant) had  better survival (64% ,64% at 3, 5 years) compared to older ones ( 40% , 24% at 3 , 5 years) (P=0,01). Nutritional autonomy was achieved on all survivors (3 are on TPN also).

Regarding multivisceral transplants, all but 2 (deceased for infection) underwent splenectomy.

Among rescue population( mean followup 734 ± 707 days-nine patients were lost), 36patients (92%) are alive (3 died),78%is off TPN, 22%is on TPN plus oral feeding. One, 3 , 5 years survival is 94%,94% , 83%.

Conclusions: Survival decreases after intestinal transplantation: in our series half population is alive. Surgical rescue allows intestinal recovery with lower mortalityand morbidity.